CHAPTER 6 of CHILDREN OF ALCOHOLISM
CLINICAL STRATEGIES FOR USE WITH ADULT CHILDREN
One of my patients entered therapy in her early twenties in order to work through the suicide of her alcoholic and tranquilizer-dependent mother, who had committed suicide when my patient was 15. This young woman could never adequately mourn her mother’s loss, because her father was completely unable to confront his own grief and deep sense of guilt over his wife’s addiction and suicide. He blocked every attempt by his daughter to express sadness, rage, or fear about her mother’s death.
This patient had received some brief psychotherapy for anxiety attacks at her university’s counseling center, but she agreed with her therapist there that she needed to tackle some relatively deep issues about her mother that could never be resolved in a short-term therapy. The patient was an extremely intelligent and articulate young woman who worked in a paraprofessional helping capacity herself. Since she was so knowledgeable about mental health work and since she had found her previous psychotherapy so helpful, she was confused and troubled by the considerable anxiety that she experienced before meeting with me each week. Her extreme fearfulness made it difficult for her to share deeper feelings with me or even to look at me very often during our sessions. During the early months of this young woman’s therapy, she had a dream that explained this intense fear .
In the dream, the patient showed her mother a small and fragile caged bird that was the daughter’s pet. The mother reached into the cage, and the patient thought, “She is going to pet the bird.” Instead of petting the bird, however, the mother grabbed the bird and crushed it.
This simple, but terribly disturbing dream revealed the entire purpose of this patient’s psychotherapy as well as her terror of embarking upon it. Actually, the most fundamental purpose of psychotherapy with any adult child is to open a hidden, imprisoned, and extremely fragile part of the self, and convince it to allow itself to be touched by another person. But these patients all fear, as this one obviously did, that if they open the door to the heart of the self, it will be crushed by the therapist, just as it was nearly crushed by the insensitivity, abuse, or betrayal of the parent(s).
Self Psychology and British Object Relations Theory prescribe a form of psychotherapy that searches out the hidden heart of the self in order to unify the psyche and allow the self to begin a new period of growth. They advocate an explicit clinical focus on the condition of vital psychic structures, especially their incompleteness, fragmentation, divisiveness, and defensiveness. Kohut, of course, believed that psychic structure is self structure. He proposed that all psychotherapeutic interventions should address, and aim at increasing, the cohesion, vitality, and harmony of the self. The British theorists, and Kohut, believed that the fundamental condition of the self, as well as transient self states, are largely dependent on the quality of the relationships between the self and its objects. They held that impairments of the self can be significantly reduced, if the therapist responds to the frustrated longings of the self as the parents could not-with understanding, acceptance, and a willingness to work toward their ultimate resolution.
This chapter applies the tenets of British Object Relations Theory and Self Psychology to self disorders in adult children of alcoholics. It advances several general principles of psychotherapy that are designed to address, and redress, the critical failures of the alcoholic home. It should be noted that, while each of these principles describes a relatively discrete aspect of psychotherapy with adult children, they are all ultimately concerned with the provision of the calm, empathic, and strong selfobject environment that was largely unavailable to the patient during childhood.
The Healing Environment: A Psychological Safety Net
The adult child’s feeling of psychological safety in psychotherapy depends on the therapist’s capacity to convince the patient that he will not be subjected to the sorts of traumatic disappointments that were commonplace occurrences in the alcoholic home. Therapeutic error, as we have learned, is an unavoidable feature of clinical practice in psychology, and while many adult children are greatly disturbed even by the therapist’s relatively small failures, these events can usually be turned to good use in the psychotherapy. As Kohut pointed out, if the therapist adequately analyzes and interprets the nature and the consequences of clinical error, mistakes can actually constitute “optimal frustrations” that strengthen the self structure. However, a constructive outcome is possible only if the therapist’s errors remain non-traumatic in nature and frequency.
Each patient has special sensitivities to particular kinds of disappointment, of course. These individual differences depend in large measure on specific traumas to which the patient has been subjected in childhood, and the amount and quality of support that the patient originally received in attempting to deal with these traumas. In general, however, there are certain basic conditions that must be met for every adult child in treatment, if the therapist is to become a “good object” who represents a viable alternative to the internalized abusive objects of the patient’s childhood.
Principle Number One
As Kohut observed, a therapist’s response to patients should be characterized by the sort of warm responsiveness to be expected from an individual whose professional life is devoted to understanding and helping others. Therapists are not mere “projection screens,” but people who have enormous importance as “real” objects. Beyond analysis and interpretation, the “real” qualities of the therapist-warm interest, caring, and respect for the patient as an individual-are the things that rekindle the hope for the future that has been mostly suffocated in a neglectful and abusive alcoholic home. The patient will excuse many instances of empathic failure if these mistakes occur in the context of the therapist’s obvious regard for the patient and the work. Not caring is an obvious clinical sin. Miller (1985) noted, in his description of the psychological supervision that he received from Kohut, that Kohut also felt that it was detrimental to pretend not to care in the interest of maintaining one’s “analytic neutrality” (p. 22).
Many adult children of alcoholics have been reared by parents with deeply flawed self structures and critically impaired self-esteem. As Kohut pointed out, parents who suffer from severe self-disorders are unable to mirror (affirm and support) distinctive and healthy aspects of a child’s unfolding self. An alcoholic and an enabling spouse are likely to thwart the natural course of self-development in a child by using a son or daughter as a container for parental self-loathing or by mirroring only those qualities of the child’s self that are necessary to bind the parent’s anxiety and stabilize the parent’s self. The parent with a self disorder may also try to crush elements in the child’s self that threaten the parent’s fragile narcissism. The therapist should look for opportunities to support the patient’s self-esteem and to encourage the expression and growth of parts of the patient’s self that were damaged and driven into hiding by parental neglect or aggression.
Jack
It was always clear to Jack that his parents expected him to excel in school and at sports, and that they were disappointed whenever he failed to turn in a first-rate performance. However, both parents were relatively cool and restrained each time he reached a new pinnacle of achievement in either realm. Their lack of enthusiasm on these occasions convinced Jack that his own feelings of excitement and self-satisfaction about his achievements was somehow “wrong” and inappropriately prideful. He tried to subdue these feelings, and in time he came to feel like a machine whose continued superb functioning was more a matter of programming than unique capacity and monumental effort. He began to believe that his triumphs deserved no special notice.
Jack’s achievements in school often received very special notice from his teachers and peers, however. For example, in junior high school he received a school-wide award for citizenship. Because Jack was accustomed to diminishing the importance and personal meaning of these sorts of honors, he planned not to mention the award to his parents.
However, the obvious excitement that his teachers and fellow students felt about his achievement convinced him that it was, in fact, something very special, and he finally decided to tell his mother what had happened. She didn’t praise Jack when he told her the news, nor did she try to share in the pleasure he felt about the recognition he had received at school. Instead, she told Jack that she and his father had both won this award when they were Jack’s age, and she began to reminisce about how she had felt on the day she had taken the prize. Jack’s excitement about his own accomplishment was crushed.
Jack’s parents needed his success as a buttress for their own sagging self-esteem. The emotional inhibition and self-preoccupation resulting from their own illnesses precluded a real empathic response to their son. They felt no joy over Jack’s occasional deep pleasure and intellectual excitement about his studies, or his own sense of gratification at receiving the admiration of others. His parents’ failure to be truly touched by these parts of him left Jack feeling empty and futile about his academic endeavors. Still, he felt compelled to succeed-for them.
Interestingly, Jack retained feelings of excitement and vitality about sports. His father was also extremely devoted to sports and demonstrated interest and some degree of pride in Jack’s athletic prowess. His father’s ability to mirror this aspect of Jack’s self undoubtedly helped it to continue to feel alive and important. On the day of a pivotal high school game, Jack was surprised and delighted to look into the stands and find both his parents in attendance. His father was usually too busy with work to attend these contests. Jack played a good game and was especially pleased to receive his father’s praise for this performance. This pleasure turned to disappointment and hurt later on, however, when his mother, acting out of apparent envy over this moment of connectedness between Jack and his father , informed Jack that his father had fallen asleep in the stands early in the game and had actually missed most of the important play.
Jack coped with his parents’ self-interested response to his achievements by concealing them. He was still, on occasion, dimly aware of feelings of pleasure connected with special things he accomplished and with the actual process of studying, working, or playing sports. He took pains to suppress and conceal these too, since he still felt they were wrong, or inappropriate in some way.
It is a testimony to the strength of Jack’s split off, core self that he was able to embark on a career path that deviated sharply from the one his parents had plotted out for him. It was inexplicable to him that he had done so, since for a long time, he had been unable to feel any strong sense of purpose or interest about his chosen work. When he felt some spark of enthusiasm in school, or at work, or when he received some special recognition or passed an academic milestone, he was understandably reluctant to feel about these events with me, or to even mention them to me. When he did mention them, they were usually things or feelings that had occurred weeks or months ago, and he was always careful to preface his remarks by saying, “I know this isn’t really worth mentioning, but. . . ” or “I don’t know if this is important to say, but. . . ” I always assured Jack that such things were crucially important for him to raise in therapy, since they were signals from the inner man, the core Jack, about who he was apart from his parents’ needs. I also made every effort to express pleasure that he was beginning, once again, to take pleasure from the work he had chosen for himself. I often referred to him as a “scholar” and a “talented clinician,” in an attempt to sharpen those aspects of Jack’s self that seemed most often to give him genuine pleasure. This always stimulated Jack’s fear that he might become prideful or hopeful about some achievement that “amount[ed] to nothing, really .’ , Very gradually, however, my mirroring of these essential qualities strengthened them and helped Jack to overcome, in great measure, his inhibitions about sharing these parts of himself with me. He also became better able to display his excitement about scholarly work and clinical practice to selected colleagues and teachers who were able to provide further mirroring.
